Why Study Doctor Xue Lizhai? More Than Three Thousand Case Records, and Famous Formulas Used to Perfection

Opening: after sixty-odd episodes, Doctor Luo wants to speak from the heart

Having told Doctor Xue Lizhai’s case records continuously for sixty-odd episodes, Doctor Luo Dalun says: we have been discussing Xue Lizhai’s case records for some time now — more than sixty episodes. Today, let me pause and take stock. He left behind far too many case records — more than three thousand, which should make him the physician who left the most case records in the entire history of Chinese medicine. So why should we study his case records and his academic thought? There is real depth to this question.

💬 Note from Doctor Luo: Savor and ponder Xue Lizhai’s case records carefully, and you can extract a great deal of experience and many patterns from them — patterns that can be used today. You can take them and apply them directly; they carry real reference value. That is the first reason to study him.

Who did he treat? — from grand secretaries down to ordinary people

Xue Lizhai lived in the Ming Dynasty. Society was relatively stable, and people lived relatively prosperous lives. He was the head of the Imperial Academy of Medicine (Tai Yi Yuan). In the early part of his career, his patients were basically all officials — grand secretaries (ge lao), for example.

💬 Note from Doctor Luo: What is a ge lao? It was the highest tier of the cabinet — the few officials who managed the state just below the emperor, such as the senior grand secretary. Their rank was extremely high — roughly the equivalent of today’s premier. Xue Lizhai treated these officials and their relatives, and those case records all survive. He also saw the emperor himself, but palace matters had to be kept confidential, so those records were never written down.

In his later years, Xue Lizhai treated the broad population. But on the whole, life across society at that time was quite good, so what people suffered from most was the diseases of prosperity (fu gui bing) — and this is strikingly similar to today.

Diseases of prosperity, emotional disorders: matching today almost exactly

In Xue Lizhai’s era, people predominantly suffered from diseases of prosperity and emotional disorders — this was not unique to him; it was the backdrop of that age.

💬 Note from Doctor Luo: In Doctor Zhang Zhongjing’s era, people were starving. In Doctor Li Dongyuan’s era, people were also starving — starving until the spleen and stomach collapsed, until people were nearly dead, and when a pathogen arrived the body could not resist. But many of us today fall ill because of prosperity — we eat too well and live too comfortably. And once you are prosperous, what do you start paying attention to? Your emotions. When you are starving and cannot even get food on the table, who has the energy to bicker with anyone? When life gets comfortable, even mother-in-law and daughter-in-law conflicts flare up with full force. So the diseases of prosperity and emotional disorders predominate.

And this is exactly where Xue Lizhai’s material matches modern life — I would say Xue Lizhai is absolutely one of the physicians whose experience matches today especially closely. So his case records, savored and pondered carefully, yield many experiences and patterns that serve today’s needs — you can take them and use them directly.

💬 Note from Doctor Luo: That is the first reason to study him — his patients and today’s us live too much alike, so his experience has direct reference value for us.

Using famous formulas to perfection: Ba Wei Wan for skin sores, and the hidden meaning of wasting-thirst

What was most special about Xue Lizhai? He took those classic formulas and used them to perfection. He has more than three thousand case records — an enormous body of work — yet no matter what he treated, it was the same few classic formulas varied again and again. That is very interesting.

💬 Note from Doctor Luo: Take external medicine, for example. When a person develops a sore or ulcer and it is eventually cured, such people very often suffer damage to their essence and fluids, and often develop wasting-thirst (xiao ke) — that is, they develop the problem of wasting-thirst. In reality, such a person may well have had wasting-thirst all along in ancient terms — an illness very similar to today’s diabetes: the body more easily develops sores. Xue Lizhai said that at this point the person’s essence and fluids are insufficient and kidney water is insufficient — what to do? You must take Ba Wei Wan (Eight-Ingredient Pill, i.e. Gui Fu Di Huang Wan), and they will recover very well — this experience we can fully use today.

There is a very interesting piece of pharmaceutical lineage here: when Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) first appeared, it was actually used to treat wasting-thirst-type diseases — which overlaps to a degree with today’s diabetes; this condition is recorded in the ancient texts. Later we gradually forgot it, but today there really are many yang-deficient, kidney-essence-deficient diabetic patients who take Jin Gui Shen Qi Wan or Gui Fu Di Huang Wan as long-term regulation, with good results.

💬 Note from Doctor Luo: Where did Xue Lizhai put it? He applied it to treating sores and ulcers. In fact, many diabetic patients develop various ulcer problems, especially in certain locations — for example necrosis of the fingertips. These are all recorded in Xue Lizhai’s external-medicine case records, and he really did treat them with Ba Wei Wan. Experiences of this kind are, I think, especially valuable — he took these formulas and used them to perfection.

Bu Zhong Yi Qi, Gui Pi, Liu Jun Zi, Liu Wei, Ba Wei, Xiao Yao San — unprecedented and unsurpassed

Beyond Ba Wei Wan, Xue Lizhai wielded his other formulas with equal mastery: for qi deficiency he used Bu Zhong Yi Qi (Tonify the Middle and Augment Qi), Gui Pi (Restore the Spleen), and Liu Jun Zi (Six Gentlemen); for kidney deficiency he distinguished clearly — kidney yin deficiency gets Liu Wei Di Huang Wan, kidney yang deficiency gets Ba Wei Wan (Gui Fu Di Huang Wan) — all applied with uncanny mastery, plus Xiao Yao San (Free and Easy Powder) for soothing the liver and resolving constraint.

💬 Note from Doctor Luo: In the way he systematized these formulas, he was unprecedented and unsurpassed. Some physicians have even said: had Xue Lizhai not promoted them this way, these formulas might never have become as famous as they are today — they might not be this well known at all. It was Xue Lizhai who lifted them up.

Ordinary people should learn Chinese patent medicines: available at the pharmacy, no need to brew decoctions every day

Xue Lizhai’s experience benefits today’s ordinary people enormously. Some diseases really do require seeing a Chinese medicine doctor, but for certain chronic conditions or imbalances, what should you do?

💬 Note from Doctor Luo: We ordinary people must learn how to use Chinese patent medicines. They are available at every pharmacy, convenient to buy at any time, and convenient to take — you do not have to brew a decoction every day. In the heat of summer, brewing a decoction fills the whole house with steam; some people say they cannot stand it. But Xue Lizhai explains the indications of these patent medicines, how to use them, and the exact regimen — morning, noon and evening — in extraordinary detail.

Doctor Luo says he has seen many friends who, after learning how to use these patent medicines and persisting with them, have already gained great relief and real improvement in their bodies, gradually moving toward health.

💬 Note from Doctor Luo: As long as the direction is correct, patent medicines may not work as fast, but used steadily they will not let the body get worse and worse — that is the first thing. Second, the body keeps moving in a better direction. The medicine was not taken in vain; it works slowly in the body, and that is a good thing.

Learning direction one: analyze the cause — emotions injure the spleen and stomach; what looks like heat is really true cold

In studying Xue Lizhai, the first thing is to analyze the cause: how do emotional problems injure the spleen and stomach?

💬 Note from Doctor Luo: When your emotions are disordered, the liver qi runs crosswise and attacks spleen earth, and the spleen and stomach are injured. Once the spleen and stomach are injured, the yuan qi is depleted. Once the yuan qi is depleted, Xue Lizhai taught, all kinds of symptoms appear. Usually we say spleen-stomach deficiency is a cold pattern — the body grows colder and colder; but Xue Lizhai discovered that many are heat patterns — they look like heat on the surface, but inside it is true cold. Xue Lizhai discussed this point especially well and at great length, so this is something we must learn.

Learning direction two: how to tonify kidney deficiency — tonify the lung to generate kidney water; Ba Wei Wan to restrain deficient fire

The second thing to learn is how to tonify the kidney: how does the kidney become deficient? Through all kinds of consumption — after all kinds of consumption, kidney qi becomes deficient. Once kidney qi is deficient, how do you tonify the kidney?

💬 Note from Doctor Luo: Xue Lizhai explained both the spleen and the kidney very clearly — how to tonify the kidney, he set out especially clearly: how to use wu wei zi (schisandra berry) to tonify the lung, and through tonifying the lung to nourish kidney yin — metal generates water; tonify the lung and the kidney water is born; how to warm kidney yang and restrain deficient fire with Ba Wei Wan. Xue Lizhai set all of this out with great clarity. As we study step by step, grasping how to tonify spleen-kidney deficiency — and how to do it with patent medicines — is especially important.

What looks like external pathogen is actually deficiency of the upright — supporting the upright as the priority is where his judgment shines

Xue Lizhai had another major idea: in his case records, many cases where the external pathogen appears obvious, or the surface presentation is obvious, are actually deficient — the body is depleted. It looks like excess of pathogen, but in truth the upright qi is deficient.

💬 Note from Doctor Luo: Xue Lizhai handled this very properly — he made supporting the upright the priority, and he judged the balance especially well. Under ordinary circumstances, we all tend to think of expelling the pathogen: clear heat and resolve toxin, dispel dampness, clear damp-heat — what we think of is usually how to remove the pathogen, how to break up blood stasis, how to move the qi. But Xue Lizhai saw that the essence of many illnesses is insufficiency of the upright qi, spleen-kidney deficiency, yuan qi deficiency — so what do you do? Support the upright qi — and by supporting the upright qi, slowly, slowly, those surface symptoms and labels get regulated and resolved. He treated the root. This is also a major direction for us in studying Xue Lizhai’s case records.

Closing: master a few formulas and you can regulate many diseases — see you at the next physician

At this point, the Xue Lizhai series has been told nearly in full. Doctor Luo says: some friends may feel that this is too much repetition — it is always the same few directions used back and forth, and below there are only a few formulas — Bu Zhong Yi Qi, Ba Wei Wan, Xiao Yao San; basically these few formulas used in rotation; too simple.

💬 Note from Doctor Luo: Ponder it slowly — there is real craft here. If you can truly master these few formulas, an enormous number of diseases can be regulated and healed. Go back and review. Next we will move on to other physicians. First, rest for a couple of days, chat about some other topics in Chinese medicine, and then we will introduce a new physician.

Xue Lizhai’s case series basically ends here. We are about to enter the content of a new physician, and the study load is heavy — let’s work hard together.

💬 Note from Doctor Luo: Thank you all for listening, thank you for your support — see you at the next physician.

What to take away

1. Why study Xue Lizhai? — More than three thousand case records, the most left by any physician in Chinese medical history, and his patients lived lives almost identical to ours: prosperous, well fed, emotionally complicated. His experience transfers directly.
2. The diseases of prosperity and emotions — Zhang Zhongjing’s and Li Dongyuan’s eras were eras of hunger; ours is an era of excess. Once life is comfortable, emotional disorders dominate — and Xue Lizhai is the physician who matches that reality best.
3. Famous formulas used to perfection — Bu Zhong Yi Qi Tang, Gui Pi Wan and Liu Jun Zi Wan for qi/spleen deficiency; Liu Wei Di Huang Wan for kidney yin; Ba Wei Wan (Gui Fu Di Huang Wan) for kidney yang; Xiao Yao San for soothing the liver. Master these few, vary them well, and countless diseases can be regulated.
4. Ba Wei Wan and wasting-thirst — Jin Gui Shen Qi Wan was originally used for wasting-thirst-type illness; many yang-deficient, kidney-essence-deficient diabetics benefit from long-term regulation with it, and Xue Lizhai even applied it to the sores and ulcers of such patients.
5. Learn patent medicines — they are at every pharmacy, easy to take, and Xue Lizhai explains indications and regimens in fine detail; used in the right direction they steadily move the body toward health.
6. Three learning directions — analyze the cause (emotions injure the liver, the liver attacks the spleen, spleen-stomach injury depletes yuan qi; apparent heat is often true cold); correct kidney tonification (tonify the lung to generate kidney water with wu wei zi; Ba Wei Wan to restrain deficient fire); and support the upright as the priority — what looks like external pathogen is often deficiency of the upright qi.

Compiled from Doctor Luo Dalun’s explanation of Doctor Xue Lizhai’s case records. The case records are from the Xue Family Case Records (Xue Shi Yi An).